COURSE NO: Nursing Care Management 104

COMMUNITY HEALTH NURSING 1

(RLE)

Prepared by NCM 104 Instructors

Learning Objectives
At the end of the virtual discussion you will be able to :
1. Obtain the pertinent data in family case study per
chapter.
2. Identify the initial data base.
3. Recognize the criteria in identifying the problem.
4. List down the Health Problems according to priorities
5. Identify the Subjective Cues & Data and Family
Nursing problem.
6. Create appropriate Family Nursing Care Plan.
 FAMILY CASE STUDY
Chapter I. INITIAL DATA BASE
Chapter II. First Level of Assessment ( List of Health
Problems and CUES
Chapter III. Second Level of Assessment (List of health
Problems with Corresponding Family Nursing
Diagnosis
Chapter IV. Prioritization (Scale for Ranking/ Criteria
in Identifying the Problem and Computation)
Chapter V. Family Nursing Care Plan
Chapter VI. Summary, Conclusion and
Recommendation
Chapter VII. Appendices (documentation)
 I.INITIAL DATA BASE
1.Family structure, characteristics, and dynamics
Member Position in the Relationship to Civil Age Sex
of the Family the head of the Status
household family
Member of the Place of Type of family Dominant General family
household residence of structure family members relationship or
each member of in terms of dynamics
the family decision making
2.Socio- economic, and cultural characteristics
Member Income and expenses
of the Occupation Place of Income of Who makes
household Work each decision about
working family
member expenditure
 3.Home and Environment
1.Housing Descripti on
• Adequacy of
living space

• Sleeping
arrangements

• Presence of
breeding sites
of vectors of
diseases
• Presence of accident
hazards

• Food storage and

cooking faciliti es

• Water supply
• Toilet facility

• Garbage disposal
• Drainage system

2. Kind of
neighborhood
3. Social and health
faciliti es available

4. Communicati on and
transportati on faciliti es
available
4.Health status of each family members (Narrati ve Form)
Health status Descripti on
1.Medical history
indicati ng current or
past signifi cant
illnesses or beliefs and
practi ces conducive to
health illness.

2. Nutriti onal
assessment /
anthropometric data,
dietary history,
eati ng / feeding
habits/practi ces.
3. Risk factor assessment
indicati ng presence of
major and contributi ng
modifi able risk factors
for specifi c lifestyle
diseases.

4.Physical assessment
indicati ng presence of
illness state/s.
5.Results of
laboratory/diagnosti c
and other screening
procedures supporti ve of
assessment fi ndings .
5.Values and practi ces on health promoti on and
maintenance and illness preventi on
Description

1.Immunizati on status

2.Healthy lifestyle
practi ces
3.Adequacy of:
• Rest and sleep
• Exercise/acti viti es
• Use of protecti ve
measures

4. Use of promoti ve-

preventi ve health ser vices
Typology of Nursing Problems in Family Nursing Practice

1. Presence of Wellness Condition-stated as potential or Readiness-a clinical or

nursing judgment about a client in transition from a specific level of wellness
or capability to a higher level. Wellness potential is a nursing judgment on
wellness state or condition based on client’s performance, current
competencies, or performance, clinical data or explicit expression of desire to
achieve a higher level of state or function in a specific area on health
promotion and maintenance. Examples of this are the following

A. Potential for Enhanced Capability for:

•Healthy lifestyle-e.g. nutrition/diet, exercise/activity
•Healthy maintenance/health management
•Parenting
•Breastfeeding
•Spiritual well-being-process of client’s developing/unfolding of mystery
through harmonious interconnectedness that comes from inner
strength/sacred source/God (NANDA 2001)
•Others. Specify.
B. Readiness for Enhanced Capability for:

•Healthy lifestyle
•Health maintenance/health management
•Parenting
•Breastfeeding
•Spiritual well-being
•Others. Specify.
2. Presence of Health Threats-conditions that are
conducive to disease and accident, or may result to
failure to maintain wellness or realize health
potential. Examples of this are the following:
A. Presence of risk factors of specific diseases (e.g. lifestyle
diseases, metabolic syndrome)
B. Threat of cross infection from communicable disease
case
C. Family size beyond what family resources can adequately
provide
D. Accident hazards specify.
• Broken chairs
• Pointed /sharp objects, poisons and medicines improperly kept
• Fall hazards
• Fire Hazard
• Others specify.
E. Faulty/unhealthful nutritional/eating habits or
feeding techniques/practices. Specify.
– Inadequate food intake both in quality and quantity
– Excessive intake of certain nutrients
– Faulty eating habits
– Ineffective breastfeeding
– Faulty feeding techniques

F. Stress Provoking Factors. Specify.

– Strained marital relationship
– Strained parent-sibling relationship
– Interpersonal conflicts between family members
– Care-giving burden
G. Poor Home/Environmental
Condition/Sanitation. Specify.
– Inadequate living space
– Lack of food storage facilities
– Polluted water supply
– Presence of breeding or resting sights of vectors of
diseases
– Improper garbage/refuse disposal
– Unsanitary waste disposal
– Improper drainage system
– Poor lightning and ventilation
– Noise pollution
– Air pollution

H. Unsanitary Food Handling and Preparation

I. Unhealthy Lifestyle and Personal
Habits/Practices. Specify.
– Alcohol drinking
– Cigarette/tobacco smoking
– Walking barefooted or inadequate footwear
– Eating raw meat or fish
– Poor personal hygiene
– Self medication/substance abuse
– Sexual promiscuity
– Engaging in dangerous sports
– Inadequate rest or sleep
– Lack of /inadequate exercise/physical activity
– Lack of/relaxation activities
– Non use of self-protection measures (e.g. non use of bed
nets in malaria and filariasis endemic areas).
J. Inherent Personal Characteristics-e.g. poor impulse control

K. Health History, which may Participate/Induce the

Occurrence of Health Deficit, e.g. previous history of difficult
labor.

L. Inappropriate Role Assumption- e.g. child assuming

mother’s role, father not assuming his role.

M. Lack of Immunization/Inadequate Immunization Status

Specially of Children

N. Family Disunity-e.g.
– Self-oriented behavior of member(s)
– Unresolved conflicts of member(s)
– Intolerable disagreement
O. Others. Specify._________
3. Presence of health deficits-instances of failure
in health maintenance.

Examples include:
A. Illness states, regardless of whether it is
dignosed or undiagnosed by medical practitioner.
B. Failure to thrive/develop according to normal
rate
C. Disability-whether congenital or arising from
illness; transient/temporary (e.g. aphasia or
temporary paralysis after a CVA) or permanent
(e.g. leg amputation secondary to diabetes,
blindness from measles, lameness from polio)
•IV. Presence of stress points/foreseeable crisis situations-anticipated
periods of unusual demand on the individual or family in terms of
adjustment/family resources. Examples of this include
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of job
K. Hospitalization of a family member
L. Death of a member
M. Resettlement in a new community
N. Illegitimacy
O. Others, specify.___________
II. First Level of Assessment
Sample
HEALTH PROBLEMS CUES

Example:
1. Inadequate Living Space - The house has a dimension of 3x4
with 6 family member
III. Second Level of Assessment
Health Problems Family Nursing Diagnosis

Inadequate living space Inability to provide a home environment

conducive to health maintenance and
personal development due to:
Inadequate family resources specifically:
Financial constraints/limited financial
resources, Limited physical resources
 Family Nursing diagnosis

1. Inability to recognize the presence of the condition

or problem due to:
A. Lack or inadequate knowledge
B. Denial about its existence or severity as a result of
fear of consequences of diagnosis of problems
Specifically: Social,
Economic/cicalost implications, Physical consequences,
Emotional/psychological
issues/concern,
C. Attitude/Philosophy in life, which hinders
recognition/acceptance of a problem
2.Inability to make decisions with respect to taking
appropriate health action due to
A.Failure to comprehend the nature/magnitude of
the problem/condition
B. Low salience of the problem condition
C. Feeling of confusion, helplessness and/or
resignation brought about by perceive magnitude
severity of the situation or problem
D.Lack of/ inadequate knowledge /insight as to
alternative
E. Inability to decide which action to take from
among a list of alternatives
F. Conflicting opinions among family
members/significant others regarding action to take
G. Lack of/inadequate knowledge of community resources for
care
H. Four consequences of action, specifically:Social
consequences, Economic consequences, Physical
consequences, Emotional/psychological consequences
I. Negative attitude towards the health conditions or problem
by negative attitude is meant one that interferes with rational
decision making
J. In accessibility of appropriate resources for care,
specifically:
Physical accessibility
Costs constraints or economic/financial inaccessibility
K. Lack of trust/confidence in the health personnel/agency
L. Misconception or erroneous information about proposed
courses of action
3. Inability to provide adequate nursing care to the sick,
disabled, dependent or vulnerable/at risk, member of the
family, due to:
A. Lack of/inadequate knowledge about the
disease/health condition
B. Lack of/inadequate knowledge about the
disease/health condition
C. Lack of the necessary facilities, equipment and
supplies of care
D. Lack of/inadequate knowledge about child
development and care
- Lack of /inadequate knowledge or skill in carrying
– Out the necessary intervention or treatment procedure
of care
E. Inadequate family resources of care specifically:
F. Absence of responsible member, Financial constraints,
Limitation of lack/lack of physical resources,
G. Significant persons unexpressed feelings which his/her
capacities to provide care
H. Philosophy in life which negates/hinder caring for the
sick, disabled, dependent, vulnerable/at risk member
I. Member’s preoccupation with no concern/interest
J. Prolonged disease or disabilities, which exhaust
supportive capacity of family members
K. Altered role performance, specify:
• Role denials or ambivalence, Role strain, Role
dissatisfaction, Role conflict, Role confusion, Role
overload.
4. Inability to provide a home environment conducive to
health maintenance and personal development due to:
A. Inadequate family resources specifically: Financial
constraints/limited financial resources, Limited physical
resources
B. Failure to see benefits (specifically long term ones) of
investment in home environment improvement
C. Lack of/inadequate knowledge of importance of
hygiene and sanitation
D. Lack of/inadequate knowledge of preventive measures
E. Lack of skill in carrying out measures to improve home
environment
F. Ineffective communication pattern within the
family members
G. Lack of supportive relationship among family
members
H. Negative attitudes/philosophy in life which is
not conducive to health maintenance and
personal development
I. Lack of inadequate competencies in relating to
each other for mutual growth and maturation
5. Failure to utilize community resources for health
care due to
A. Lack of inadequate knowledge of community
resources for health care
B. Failure to perceive the benefits of health
care/service
C. Lack of trust/confidence in the agency personnel
D. Previous unpleasant experience with health
worker
E. Fear of consequences of action specifically:
physical/psychological consequences, financial
consequences.
IV. Prioritization (Scale for Ranking/ Criteria in Identifying the
Problem and Computation) SAMPLE
CRITERIA COMPUTA ACTUAL JUSTIFICATION
TION SCORE
1. Nature of 2/3 X 1 2/3 It is a health threat
the Problem
Health threat

2.Modifiability
Intermediate
½ X2 1 Increasing the living space will require quite
a financial expenditure. The family’s
modifiable resources are presently not adequate

3.Preventive 3/3 x 1 1 Increasing the living space will

Potential provide bigger space to allow adequate
High movement when performing housework

4. Salience of 0/3 x 1 0 It is not perceived as a problem or condition

the problem needing change
TOTAL 2 2/3
CRITERIA FOR PRIORITIZATION OF HEALTH
PROBLEMS
1. NATURE OF THE PROBLEM- categorized into
:
a. health deficit
b. health threat
c. and foreseeable crisis
2. MODIFIABILITY OF THE PROBLEM-
refers to the probability of success in
minimizing, alleviating or totally eradicating the
problem through intervention
a. Easily modifiable
b. Partially modifiable
c. Not modifiable
3. PREVENTIVE POTENTIAL- refers to the
nature and magnitude of future problems that
can be minimized or totally prevented if
intervention is done on the problem under
consideration
a. High
b. Moderate
c. Low
4. SALIANCE OF THE PROBLEM- refers to
the family’s perception and evaluation of the
problem in terms of seriousness and urgency of
attention needed (most important)
a. A serious problem, immediate attention
needed
b. A problem, but not needing immediate
attention
c. Not a felt
 CRITERIA IN IDENTIFYING
CRITERIA SCORE
THE PROBLEM
WEIGHTI
I. Nature: assess by PHN
Health Deficit (HD) 3 1
Health Threat (HT) 2
Foreseeable Crisis (FC) 1

II. Modifiability
Easy 2 2
Intermediate(moderate) 1
Not modifiable 0

III. Preventive Potential

Highly 3 1
Moderate 2
Low 1

IV. Salience of the Problem

Problem needing urgent attention 2 1
Problem not needing urgent attention 1
Not a felt problem 0
*Steps *
a. Decide on a score
b. Score

__________ X Weight
Highest Score
c. Get the sum total of all the scores

*Interpretation *
• Perfect score=5, if score nearing 5 then prioritize the
problem
• Criteria 1,2&3 has to be assessed objectively by the health
worker
• Criteria 4has be assessed by the perception of the family
 List of Problems Ranked According to Priorities

Health problem Score

1.

2.
 V. Family Care Plan
Health Family Goal of Objectiv Interven Exoecte Nursing Method Resourc
Problem Nursing Care e of tion d Interveti of es
Problem Care Outcom on Nurse-
e patient
Contact
1.
2.
3.
Chapter VI. Summary, Conclusion
and Recommendation
A. Summary:
B. Conclusion:
C. Recommendation: